RESUMEN
Midwives and general practice nurses are ideally positioned to provide nutrition education to pregnant women. However, it appears that they do not receive sufficient nutrition training to enable them to fulfil this role. This study aimed to develop, implement and evaluate a suite of learning resources developed specifically for midwives, general practice nurses and student nurses. A four-module suite of learning resources was developed based on recommendations in the Australian Antenatal Care Clinical Guidelines as well as formative evaluation with stakeholders. The feasibility of these modules was tested using a pre-test and post-test quasi-experimental design with three arms using convenient sampling (face-to-face with midwives; online with student nurses; and online with midwives, nurses and practice nurses). Completion rates across the three study arms were poor (n=40 participants in total). For the combined data, there was a significant increase in knowledge scores across all modules from the pretest score (median (IQR): 3.46 (2.09-4.13)) to the post-test score (5.66 (4.66-6.00)) (p<0.001). Studies of high quality are required to determine if changing the nutrition knowledge and confidence in delivering nutrition care of health professionals results in sustainable changes to their clinical practice.
RESUMEN
A significant proportion of pharmaceuticals are fluorinated and selecting the site of fluorine incorporation can be an important beneficial part a drug development process. Here we describe initial experiments aimed at the development of a general method of selecting optimum sites on pro-drug molecules for fluorination, so that metabolic stability may be improved. Several model biphenyl derivatives were transformed by the fungus Cunninghamella elegans and the bacterium Streptomyces griseus, both of which contain cytochromes P450 that mimic oxidation processes in vivo, so that the site of oxidation could be determined. Subsequently, fluorinated biphenyl derivatives were synthesised using appropriate Suzuki-Miyaura coupling reactions, positioning the fluorine atom at the pre-determined site of microbial oxidation; the fluorinated biphenyl derivatives were incubated with the microorganisms and the degree of oxidation assessed. Biphenyl-4-carboxylic acid was transformed completely to 4'-hydroxybiphenyl-4-carboxylic acid by C. elegans but, in contrast, the 4'-fluoro-analogue remained untransformed exemplifying the microbial oxidation - chemical fluorination concept. 2'-Fluoro- and 3'-fluoro-biphenyl-4-carboxylic acid were also transformed, but more slowly than the non-fluorinated biphenyl carboxylic acid derivative. Thus, it is possible to design compounds in an iterative fashion with a longer metabolic half-life by identifying the sites that are most easily oxidised by in vitro methods and subsequent fluorination without recourse to extensive animal studies.
Asunto(s)
Cunninghamella/química , Hidrocarburos Fluorados/síntesis química , Preparaciones Farmacéuticas/síntesis química , Streptomyces griseus/química , Cunninghamella/metabolismo , Halogenación , Hidrocarburos Fluorados/química , Hidrocarburos Fluorados/metabolismo , Estructura Molecular , Preparaciones Farmacéuticas/química , Preparaciones Farmacéuticas/metabolismo , Streptomyces griseus/metabolismoRESUMEN
The dialysis procedure should be individually tailored to the client at all times. Learn each client's signs and symptoms for a hypotensive occurrence as well as other signals that suggest the need to adjust fluid removal when aiming for or establishing a new dry weight. Clients may display a variety of indicators, and it is imperative to familiarize yourself as much as possible with client-specific symptoms. Some clients also exhibit specific symptoms prior to actually experiencing a blood pressure drop. Learning these "red flags" is also important.